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JAMA. 1999;281:1856.

In the April 28 Resident Physician Forum, we reported on the recommendations and actions of the National Bipartisan Commission on the Future of Medicare. Two other governmental bodies, the Medicare Payment Advisory Commission (MedPAC) and the Council on Graduate Medical Education (COGME), are in the process of discussing Medicare funding of graduate medical education (GME). To help residents understand the framework of these discussions, we have summarized the membership and purpose of these groups below.

MedPAC
Congress created MedPAC in the Balanced Budget Act of 1997 by combining 2 existing commissions: the Physician Payment Review Commission and the Prospective Payment Assessment Commission. MedPAC is responsible for reporting on all Medicare payment policies, including payments to teaching hospitals for residency training. It is required to report to Congress annually.

MedPAC has collected testimony on GME funding and workforce issues, including methods of GME funding, payment for teaching physicians and allied health professionals, the role and funding of international medical graduates, and specialty and geographic distribution of physicians and residents. The next report on GME funding and workforce planning is due in August.

MedPAC is a nonpartisan group with 17 members whose expertise includes economics, health facility management, health plans and integrated delivery systems, reimbursement, medical practice, and other aspects of health services. Members were selected to also provide broad geographic representation and a balance between urban and rural representatives. Elderly recipients of Medicare benefits are also represented. Transcripts of meetings, testimony, and reports are available on MedPAC's Web site at www.medpac.gov.

COGME
Congress created COGME in 1986 and has authorized and funded the group until 2002. COGME is charged with providing an ongoing assessment of trends in the physician workforce, GME funding policies, and other aspects of residency training. COGME also considers funding for undergraduate medical education. It is required to make recommendations to Congress and the US Department of Health and Human Services.

COGME also comprises 17 members, representing primary care physicians, specialty societies, international medical graduates, medical student and resident associations, medical and osteopathic schools, teaching hospitals, health insurers, business, labor, the US Department of Health and Human Services, and the Veterans Administration.

COGME has issued 14 reports on such topics as the geographic and specialty distribution of physicians, managed care's influence on GME, international medical graduates, and women and minorities in medicine. Its reports include recommendations on federal policy and actions by teaching hospitals and medical schools to address future physician workforce needs. Reports and meeting information can be found on their Web site at www.cogme.gov.

Prepared by Ashish Bajaj, Department of Resident and Fellow Services, American Medical Association.

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